US20050263563A1 - Surgical stapling device - Google Patents
Surgical stapling device Download PDFInfo
- Publication number
- US20050263563A1 US20050263563A1 US11/125,790 US12579005A US2005263563A1 US 20050263563 A1 US20050263563 A1 US 20050263563A1 US 12579005 A US12579005 A US 12579005A US 2005263563 A1 US2005263563 A1 US 2005263563A1
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- Prior art keywords
- surgical stapling
- stapling device
- assembly
- frame
- stiffener plate
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- Legal status (The legal status is an assumption and is not a legal conclusion. Google has not performed a legal analysis and makes no representation as to the accuracy of the status listed.)
- Abandoned
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- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B2017/00367—Details of actuation of instruments, e.g. relations between pushing buttons, or the like, and activation of the tool, working tip, or the like
- A61B2017/00371—Multiple actuation, e.g. pushing of two buttons, or two working tips becoming operational
- A61B2017/0038—Simultaneous actuation of two tools by pushing one button or the like
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/068—Surgical staplers, e.g. containing multiple staples or clamps
- A61B17/072—Surgical staplers, e.g. containing multiple staples or clamps for applying a row of staples in a single action, e.g. the staples being applied simultaneously
- A61B2017/07214—Stapler heads
- A61B2017/07257—Stapler heads characterised by its anvil
- A61B2017/07264—Stapler heads characterised by its anvil characterised by its staple forming cavities, e.g. geometry or material
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B17/2909—Handles
- A61B2017/2925—Pistol grips
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/28—Surgical forceps
- A61B17/29—Forceps for use in minimally invasive surgery
- A61B2017/2926—Details of heads or jaws
- A61B2017/2945—Curved jaws
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B17/00—Surgical instruments, devices or methods, e.g. tourniquets
- A61B17/32—Surgical cutting instruments
- A61B2017/320052—Guides for cutting instruments
-
- A—HUMAN NECESSITIES
- A61—MEDICAL OR VETERINARY SCIENCE; HYGIENE
- A61B—DIAGNOSIS; SURGERY; IDENTIFICATION
- A61B90/00—Instruments, implements or accessories specially adapted for surgery or diagnosis and not covered by any of the groups A61B1/00 - A61B50/00, e.g. for luxation treatment or for protecting wound edges
- A61B90/08—Accessories or related features not otherwise provided for
- A61B2090/0807—Indication means
- A61B2090/0811—Indication means for the position of a particular part of an instrument with respect to the rest of the instrument, e.g. position of the anvil of a stapling instrument
Definitions
- the present disclosure relates generally to a surgical stapling apparatus and, more specifically, to a surgical stapling apparatus having a single trigger for approximating anvil and cartridge assemblies and for ejecting an array of staples from the cartridge assembly.
- Surgical stapling instruments used for applying parallel rows of staples through compressed living tissue are well known in the art, and are commonly used, for example, for closure of tissue or organs prior to transection, prior to resection, or in anastomoses, and for occlusion of organs in thoracic and abdominal procedures.
- such surgical stapling instruments include an anvil assembly, a cartridge assembly for supporting an array of surgical staples, an approximation mechanism for approximating the anvil and cartridge assemblies, an alignment pin assembly for capturing tissue between the cartridge and anvil assemblies and for maintaining alignment between the cartridge and anvil assemblies during approximation and firing, and a firing mechanism for ejecting the surgical staples from the cartridge assembly.
- the approximation mechanism and the firing mechanism generally include distinct actuators for effecting approximation and firing of the staples.
- the alignment pin assembly can be manually operated to advance an alignment pin from the cartridge assembly into engagement with the anvil or, alternatively, the alignment pin assembly can be automatically actuated upon operation of the approximation mechanism.
- the actuator for the alignment pin assembly is disposed at a location spaced from the handle of the instrument.
- Pruitt's instrument includes a manually operated alignment pin assembly, an approximation mechanism including a rotatable knob actuator and a firing mechanism including a pivotable trigger.
- an approximation mechanism including a rotatable knob actuator and a firing mechanism including a pivotable trigger.
- a surgeon must first approximate the anvil and cartridge members by rotating the knob actuator.
- the surgeon can advance the alignment pin assembly by advancing a knob supported on the central body portion of the instrument.
- the instrument can be fired by pivoting the trigger towards a stationary handle of the instrument.
- U.S. Pat. No. 5,697,543 to Burdorff also discloses a surgical stapling instrument having an approximation mechanism, a firing mechanism and an alignment pin mechanism.
- the approximation and firing mechanisms each include a distinct pivotable trigger actuator.
- the alignment pin mechanism is operatively associated with the approximation mechanism such that upon actuation of the approximation mechanism, the alignment pin assembly is automatically advanced.
- a surgical stapling instrument which can be operated by a surgeon with a single hand and which includes an alignment pin assembly which can be automatically or manually advanced.
- a surgical stapling device which includes a frame having a proximal end and a distal end.
- a body defining a stationary handle is secured to the proximal end of the frame.
- a head portion including an anvil assembly and a cartridge assembly are supported on the distal end of the frame.
- the anvil and cartridge assemblies are movable in relation to each other between spaced and approximated positions.
- An approximation mechanism includes a clamp slide assembly having a distal end configured to support the cartridge assembly and a proximal end.
- a firing mechanism includes a thrust bar having a distal end positioned to be slidably received within the cartridge assembly.
- a pivotable trigger is supported on the body and is operably associated with the approximation mechanism and the firing mechanism such that the trigger is pivotable through an approximation stroke to approximate the anvil and cartridge assemblies and, subsequently, pivotable through a firing stroke to eject an array of staples from the cartridge assembly.
- the presently disclosed surgical stapling device also has an alignment pin assembly which includes an alignment pin, a pin pusher and a bell crank.
- the alignment pin pusher is slidably supported on the frame between advanced and retracted positions.
- the alignment pin pusher includes a distal abutment member for engaging and advancing the alignment pin from a retracted position located within the cartridge assembly to an advanced position engaging the anvil assembly.
- the bell crank is operably connected to the clamp slide assembly and is releasably coupled to the pin pusher. Upon advancement of the clamp slide assembly, the bell crank is pivoted to concurrently advance the alignment pin pusher.
- the alignment pin pusher includes a pair of posts which extend through slots in the body. A thumb button is supported on each post.
- the thumb button(s) can be pushed prior to approximation of the device to manually advance the alignment pin assembly into engagement with the anvil assembly.
- the thumb buttons are positioned on the body such that a surgeon is able to manually advance the alignment pin assembly using the same hand that actuates the pivotable trigger.
- a pawl mechanism is supported in the body and includes a clamping pawl and a firing pawl.
- the clamping pawl functions to prevent return of the approximation mechanism after the trigger has moved through approximately three quarters of the approximation stroke.
- the clamping pawl also provides an audible and tactile indication that the device has been moved to the approximately three quarter approximated position.
- the firing pawl functions to provide an audible indication that the device is in a fire-ready position.
- the firing pawl also functions to lock the trigger in a compressed position after firing of the device has occurred to provide a visual indication that firing has occurred.
- a release button is provided to return the approximation mechanism to the retracted position at any point of operation of the device.
- the pivotable trigger, the release button and the thumb button are all disposed adjacent the handle portion of the device and are operable by the surgeon using a single hand.
- the anvil assembly of the surgical stapling device is provided with a stiffener plate to provide increased strength to the assembly.
- the stiffener plate By using the stiffener plate, the head portion profile can be reduced in size.
- FIG. 1 is a perspective view of one embodiment of the presently disclosed surgical stapling device
- FIG. 2 is a side view of the surgical stapling device shown in FIG. 1 ;
- FIG. 3 is a top view of the surgical stapling device shown in FIG. 1 ;
- FIG. 4 is a perspective view with parts separated of the surgical stapling device shown in FIG. 1 ;
- FIG. 5 is a perspective view of the surgical stapling device shown in FIG. 1 with the left body half-section removed from the handle portion of the device;
- FIG. 6 is a perspective view of the handle portion of the surgical stapling device shown in
- FIG. 7 with a body half-section removed and a portion of the frame cutaway
- FIG. 7 is an enlarged view of the indicated area of detail shown in FIG. 4 ;
- FIG. 8 is a rear perspective view of the staple pusher assembly of the surgical stapling device shown in FIG. 1 ;
- FIG. 8A is a rear perspective view of the staple pusher assembly shown in FIG. 8 with parts separated;
- FIG. 8B is a perspective view of an alternate embodiment of the staple pusher assembly shown in FIG. 8 with parts separated;
- FIG. 8C is a perspective view of the staple pusher assembly shown in FIG. 8B in an assembled state
- FIG. 9 is an enlarged perspective view of the distal end of the surgical stapling device shown in FIG. 1 ;
- FIG. 9A is an enlarged view of the indicated area of detail shown in FIG. 9 ;
- FIG. 9B is a cross-sectional view taken along section lines 9 B- 9 B of FIG. 9A ;
- FIG. 10 is a perspective view from one side of the firing pawl of the surgical stapling device shown in FIG. 1 ;
- FIG. 10A is a perspective view from the other side of the firing pawl shown in FIG. 10 ;
- FIG. 11 is a perspective view from one side of the clamping pawl of the surgical stapling device shown in FIG. 1 ;
- FIG. 11A is a perspective view from the other side of the clamping pawl shown in FIG. 11 ;
- FIG. 12 is a perspective view with parts separated of the trigger and firing link of the surgical stapling device shown in FIG. 1 ;
- FIG. 13 is a perspective view with parts separated of the release button assembly and bi-linkage assembly of the surgical stapling device shown in FIG. 1 ;
- FIG. 14 is a perspective view with parts separated of the pin pusher and bell crank of the surgical stapling device shown in FIG. 1 ;
- FIG. 15 is a side cross-sectional view of the surgical stapling device taken along section lines XX-XX of FIG. 3 ;
- FIG. 15A is a side partial cutaway view of the handle portion of the surgical stapling device shown in FIG. 1 with a body half-section removed;
- FIG. 15B is an enlarged view of the indicated area of detail shown in FIG. 15 ;
- FIG. 15C is an enlarged view of the indicated area of detail shown in FIG. 15A ;
- FIG. 16 is a side cross-sectional view of the surgical stapling device shown in FIG. 1 during approximation of the anvil and cartridge assemblies;
- FIG. 16A is a side partial cutaway view of the handle portion of the surgical stapling device shown in FIG. 1 during approximation of the anvil and cartridge assemblies with the left body half-section removed from the handle portion of the device;
- FIG. 16B is an enlarged view of the indicated areas of detail shown in FIG. 16 ;
- FIG. 16C is an enlarged view of the indicated area of detail shown in FIG. 16A .
- FIG. 17 is a side cross-sectional view of the surgical stapling device shown in FIG. 1 in the approximated position with the trigger in the compressed position;
- FIG. 17A is a side partial cutaway view of the handle portion of the surgical stapling device shown in FIG. 1 in the approximated position with the left body half-section and frame removed from the handle portion of the device and the trigger in the compressed position;
- FIG. 17B is an enlarged view of the indicated area of detail shown in FIG. 17 ;
- FIG. 17C is an enlarged view of the indicated area of detail shown in FIG. 17A .
- FIG. 18 is a side cross-sectional view of the surgical stapling device shown in FIG. 1 in the approximated position with the trigger in a fire-ready position;
- FIG. 18A is a side partial cutaway view of the handle portion of the surgical stapling device shown in FIG. 1 in the fully approximated position with the left body half-section and frame removed from the handle portion of the device and the trigger in a fire-ready position;
- FIG. 18B is an enlarged view of the indicated area of detail shown in FIG. 18 ;
- FIG. 18C is an enlarged view of the indicated area of detail shown in FIG. 18A .
- FIG. 19 is a side cross-sectional view of the surgical stapling device shown in FIG. 1 after the device has been fired with the trigger in a compressed and locked position;
- FIG. 19A is a side partial cutaway view of the handle portion of the surgical stapling device shown in FIG. 1 in the fired position with the left body half-section and frame removed from the handle portion of the device and the trigger in the compressed position;
- FIG. 19B is an enlarged view of the indicated area of detail shown in FIG. 19 ;
- FIG. 19C is an enlarged view of the indicated area of detail shown in FIG. 19A .
- FIG. 20 is a side cross-sectional view of the surgical stapling device shown in FIG. 1 after the staples have been fired from the staple cartridge and the cartridge assembly has been moved to the retracted position;
- FIG. 20A is an enlarged view of the indicated area of detail shown in FIG. 20 ;
- FIG. 21 is a top view of tissue illustrating the staple configuration applied to tissue by the surgical stapling device shown in FIG. 1 ;
- FIG. 22 is a top view of the tissue shown in FIG. 16 illustrating the staple configuration after the tissue has been cut;
- the presently disclosed surgical stapling device shown generally as 10 in FIGS. 1-3 includes a body 12 defining a stationary handle 14 , a pivotable trigger 16 , an elongated central body portion 18 , a cartridge assembly 20 and an anvil assembly 22 .
- a thumb button 24 is slidably positioned on each side of body 12 .
- Thumb buttons 24 are movable to manually advance an alignment pin assembly in a manner to be described in detail below.
- a release button 150 of release mechanism 26 is positioned on the proximal end of body 12 and is depressible to allow cartridge assembly 20 to return from an approximated position disposed adjacent to anvil assembly 22 to a position spaced from anvil assembly 22 (as shown). Operation of release mechanism 26 will also be described in detail below.
- body 12 is formed from a pair of molded half-sections 12 a and 12 b .
- half-sections 12 a and 12 b are formed of plastic, although other materials including metals may be used to form the half-sections.
- a cushioned gripping member 14 a is secured to stationary handle 14 of each half-section 12 a and 12 b .
- Gripping member 14 a may be formed by injection molding a thermoplastic elastomer, such as VersaflexTM or Santaprene, to stationary handle 14 .
- cushioned gripping member 14 can be formed on or secured to stationary handle 14 using any known fastening technique including adhesives, screws, welding, overmolding, etc.
- a pair of spaced frame members 28 a and 28 b extend between housing half-sections 12 a and 12 b and anvil assembly 22 .
- a central portion of frame members 28 a and 28 b form elongated central body portion 18 .
- frame members 28 a and 28 b are formed of a surgical grade metal such as stainless steel. Alternately, other suitable materials meeting the requisite strength requirements may also be used.
- anvil assembly 22 includes a stiffener plate 30 , a spacer plate 32 , a T-track 34 , and an anvil 36 .
- An opening 67 is formed in anvil 36 to allow passage of alignment pin 38 .
- Stiffener plate 30 has a vertical portion 30 a and a horizontal portion 30 b .
- a notch 30 c is formed in the distal end of vertical portion 30 a .
- Notch 30 c is configured to receive the tip 38 a of a cartridge alignment pin 38 .
- Horizontal portion 30 b of plate 30 includes a cutout 40 dimensioned to receive an interlock member 42 which will be discussed in further detail below.
- a distal vertical portion of frame members 28 a and 28 b are positioned on opposite sides of vertical portion 30 a of stiffener plate 30 .
- Spacer plate 32 includes a pair of legs which are positioned on opposite sides of stiffener plate 30 between stiffener plate 30 and anvil 36 .
- Anvil 36 defines a channel 36 a and is positioned about spacer plate 32 .
- a cap 39 is positioned over the assembly to provide a smoother surface which is less likely to snag tissue during use.
- Cap 39 includes a groove 39 a which defines one end of a cutting guide slot 41 formed between anvil 36 and frame member 28 b . Groove 39 a and cutting guide slot 41 facilitate cutting of tissue with a scalpel after device 10 has been fired.
- T-track 34 defines a through slot 45 .
- Slot 45 is positioned over horizontal portion 30 b of stiffener plate 30 between frame members 28 a and 28 b .
- T-track 34 is positioned about cutout 40 to define a cavity in which interlock 42 is positioned.
- the anvil assembly components and frame members 28 a and 28 b are secured together using rivets 44 ( FIG. 5 ).
- other fastening members may be used to secure the anvil assembly components and the frame members together including screws, pins, welding, etc.
- the components of anvil assembly 22 are formed of stainless steel. Alternately, other materials, including metals, having requisite strength requirements can be used to form some or all of the anvil components.
- anvil 36 includes a plurality of staple pockets 37 formed in the surface of the anvil.
- Each staple pocket 37 includes first and second staple forming cups 37 a and 37 b and a channeling surface 37 c disposed around each of the staple forming cups.
- An anvil including such a staple forming pocket has been disclosed in U.S. Pat. No. 5,480,089 filed Aug. 19, 1994, the entirety of which is incorporated herein by reference.
- cartridge assembly 20 includes a cartridge 50 having an array of staple receiving slots 52 .
- a staple pusher assembly 54 includes a plurality of pusher members 58 .
- Each pusher member 58 includes a plurality of fingers 58 a configured to be slidably received within a respective staple receiving slot 52 .
- Fingers 58 a are positioned behind staples 56 in slots 52 such that advancement of fingers 58 a effects ejection of staples 56 from slots 52 .
- a guide channel 60 ( FIG. 15 ) formed in cartridge 50 is configured to slidably receive alignment pin 38 .
- a spring 64 is positioned about pin 38 to urge alignment pin 38 to a retracted position within guide channel 60 .
- An opening 65 formed in cartridge 50 allows alignment pin 38 to extend from guide channel 60 through anvil opening 67 ( FIG. 9A ) into notch 30 c formed in anvil assembly 22 . Operation of the alignment pin mechanism for advancing alignment pin 38 will be described in detail below.
- staple pusher assembly 54 includes multiple pusher members 58 which interengage to form pusher assembly 54 .
- Pusher assembly 54 may be modified by adding or subtracting pusher members 58 to accommodate different size cartridges.
- a pusher member 58 can be removed from the assembly such as shown in FIGS. 8B and 8C to accommodate a smaller cartridge assembly.
- surgical stapling device 10 includes a pair of clamp slide members 66 a and 66 b , an alignment pin pusher 68 and a thrust bar 70 .
- Clamp slide members 66 a and 66 b , alignment pin pusher 68 and thrust bar 70 are slidably supported between frame members 28 a and 28 b for movement between retracted and advanced positions in response to movement of trigger 16 through an approximation stroke and/or a firing stroke. Operation of each of the above members will be described in detail below.
- Clamp slide members 66 a and 66 b form part of the approximation mechanism of the surgical stapling device.
- Each clamp slide member has a distal end 72 , a proximal end 74 and an elongated body 76 .
- Elongated body 76 includes a pair of elongated guide slots 78 a and 78 b .
- Guide slots 78 a and 78 b are dimensioned to slidably receive pins 80 a and 80 b ( FIG. 15 ), respectively, which extend between frame members 28 a and 28 b .
- each clamp slide member 66 a and 66 b includes a head portion 82 .
- Each head portion 82 has a plurality of openings 84 configured to receive a fastening member 86 ( FIG. 5 ) for securing clamp slide members 66 a and 66 b together in spaced relation.
- clamp slide members 66 a and 66 b are spaced from each other to define an elongated channel in which pin pusher 68 and thrust bar 70 are slidably disposed.
- Distal end 72 of clamp slide members 66 a and 66 b define a cartridge support receptacle for receiving cartridge assembly 20 .
- a series of dimples 85 on each of the clamp slide members function to frictionally retain cartridge assembly 20 within the cartridge support.
- Proximal end 74 of clamp slide members 66 a and 66 b each include a hole 87 for receiving a pin 88 of the actuation assembly which will be described in detail below.
- alignment pin pusher 68 defines a channel 69 along its length which is dimensioned to slidably receive thrust bar 70 .
- Alignment pin pusher 68 includes a vertical portion 90 having an abutment member 91 configured to engage the proximal end 38 b ( FIG. 4 ) of alignment pin 38 such that when alignment pin pusher 68 is moved to an advanced position (in the manner described below), alignment pin 38 is advanced from within cartridge 50 through opening 65 in cartridge 50 and opening 67 in anvil 36 into notch 30 c of anvil assembly 22 .
- Alignment pin pusher 68 includes a pair of elongated slots 92 a and 92 b . Pins 80 a and 80 b ( FIG.
- alignment pin pusher 68 extends through slots 92 a and 92 b , respectively, to guide alignment pin pusher 68 during movement between the advanced and retracted positions.
- the proximal end of alignment pin pusher 68 includes a pair of spaced legs 68 a and 68 b .
- Each leg 68 a and 68 b includes a radially extending post 120 which is dimensioned to extend through elongated slots 122 ( FIG. 4 ) formed in body half-sections 12 a and 12 b .
- Thumb buttons 24 are fastened to posts 120 to facilitate manual actuation of alignment pin pusher 68 .
- a C-clip receptacle 126 is formed on alignment pin pusher 68 and is dimensioned to releasably receive link 94 of bell crank 96 . Operation of bell crank 96 and the handle actuation assembly will be described in detail below.
- thrust bar 70 is slidably positioned within channel 69 defined within alignment pin pusher 68 .
- the distal end of thrust bar 70 includes an engagement head 100 configured to engage staple pusher assembly 54 .
- Thrust bar 70 also includes a pair of elongated slots 102 a and 102 b which are dimensioned to slidably receive pins 80 a and 80 b ( FIG. 15 ).
- pins 80 a and 80 b function not only to guide the movement of thrust bar 70 between the retracted and advanced positions, but also to define the fully advanced and fully retracted positions of thrust bar 70 . As illustrated in FIG.
- slots 102 a and 102 b in thrust bar 70 are longer than slots 78 a and 78 b formed in clamp slides 66 a and 66 b , respectively.
- the increased length of slots 102 a and 102 b permit thrust bar 70 to be advanced distally from the approximated position independently of clamp slides 66 a and 66 b through cartridge assembly 20 to eject staples from cartridge assembly 20 .
- the proximal end of thrust bar 70 is adapted to engage a biasing member 71 which is supported in tension between frame 28 a and thrust bar 70 to urge thrust bar 70 to the retracted position.
- the proximal end of thrust bar 70 also includes a notch 104 which is configured to receive the distal end of a firing link 106 and will be discussed in further detail below.
- a handle actuation assembly includes pivotable trigger 16 , a bi-linkage assembly 111 including a front link 112 and a rear link 114 , bell crank 96 , firing link 106 a clamping pawl 108 and a firing pawl 110 .
- a release mechanism 26 includes a release button 150 and a release lever 152 provided within body 12 .
- Pivotable trigger 16 is pivotably secured between body half-sections 12 a and 12 b about pivot members 116 which are integrally formed on opposite sides of trigger 16 .
- a pivot pin can be used to pivotably support trigger 16 between the body half-sections.
- Trigger 16 includes a cushioned grip 16 a , which may be secured to trigger 16 in the manner discussed above with respect to stationary handle 14 , and a rearward extension 115 positioned beneath bi-linkage assembly 111 .
- Rear link 114 of bi-linkage assembly 111 has a rear end pivotably secured about pivot pin 113 which extends between body members 12 a and 12 b and a forward end pivotably fastened to the rear end of front link 112 by pivot pin 118 .
- release button 150 is also pivotably secured to pivot pin 113 .
- the forward end of front link 112 is pivotably fastened to clamp slide members 66 a and 66 b by pin 88 .
- rearward extension 115 urges bi-linkage assembly 111 from a position in which the longitudinal axes of front and rear links 112 and 114 are misaligned to a position in which the axes of front and rear links 112 and 114 are substantially aligned. In the substantially aligned position, links 112 and 114 are moved to an overcenter position slightly past actual alignment.
- bi-linkage assembly 111 By moving the bi-linkage assembly slightly overcenter or past the aligned position, bi-linkage assembly 111 will not return to the misaligned position until engaged by the release mechanism 26 . Since the rear end of rear link 114 is fastened within body 12 , as bi-linkage assembly 111 is moved from the misaligned to the aligned position, front link 112 is advanced distally to advance clamp slide members 66 a and 66 b distally. Advancement of clamp slide members 66 a and 66 b effects corresponding advancement of cartridge assembly 20 to effect approximation of anvil and cartridge assemblies 22 and 20 , respectively.
- thrust bar 70 includes a forward elongated slot 103 .
- Rivets 117 which extend between clamp slide members 66 a and 66 b , also extend through slot 103 .
- rivets 117 engage the forward end of slot 103 to advance thrust bar 70 concurrently with clamp slide members 66 a and 66 b .
- slot 103 is of a length to allow thrust bar 70 to advance distally beyond the approximated position independently of clamp slide members 66 a and 66 b.
- bell crank 96 is pivotably secured between frame members 28 a and 28 b by pivot member 134 .
- link 94 of bell crank 96 is releasably positioned within C-clipl 26 of alignment pin pusher 68 .
- Bell crank 96 includes a pair of spaced sidewalls 96 a and 96 b .
- Each sidewall includes an inwardly extending cam member 138 which is configured to be received within a cam slot 140 formed in the proximal end of clamp slides 66 a and 66 b .
- cam slots 140 engage cam members 138 to pivot bell crank 96 about pivot member 134 .
- cam slots 140 are configured to quickly pivot bell crank 96 during the initial advancement of clamp slides 66 a and 66 b such as to quickly advance alignment pin pusher 68 and alignment pin 38 during the initial stage of approximation.
- release mechanism 26 includes release button 150 and release lever 152 .
- release button 150 includes a rear end which is pivotably secured to pivot pin 113 .
- Pivot pin 113 is secured between body members 12 a and 12 b .
- the forward end of release button 150 includes a slot 154 dimensioned to slidably receive a rod 156 formed on a rear end of release lever 152 .
- the forward end of release lever 152 is pivotably secured between body half-sections 12 a and 12 b .
- An engagement member 158 projects downwardly from the bottom of release lever 152 and is positioned to abut bi-linkage assembly 111 when release button 150 is depressed to urge bi-linkage assembly 111 from the substantially aligned overcenter position to the misaligned position.
- surgical stapling apparatus 10 includes a pawl assembly including clamping pawl 108 and firing pawl 110 .
- Clamping pawl 108 is pivotably secured about pivot member 170 in semi-circular slot 172 ( FIG. 4 ) in frame 28 a .
- a spring 174 is secured between clamping pawl 108 and frame 28 a to urge clamping pawl 108 to rotate in a clockwise direction as viewed in FIG. 4 .
- Clamping pawl 108 includes a cam surface 176 having a recess 178 positioned to engage cam member 180 ( FIG. 16B ) formed on extension 115 of trigger 16 .
- Firing pawl 110 is pivotably secured about pivot member 184 in semi-circular slot 186 ( FIG. 4 ) formed in frame 28 b .
- Spring 188 is secured between firing pawl 110 and frame 28 b to urge the firing pawl in a clockwise direction as viewed in FIG. 4 .
- Firing pawl 110 includes a cam surface 190 having a recess 192 for engaging a cam member 180 ′ formed on a side of extension 115 of trigger 16 opposite cam member 180 .
- cam member 180 ′ is moved into recess 192 to lock trigger 16 in a compressed position after firing has been completed. This provides an audible and visual indication to the surgeon that firing has been completed. Additional operational details of the pawl assembly will be described in the following description of the operation of surgical stapling device 10 .
- FIGS. 15-20A Operation of the surgical stapling device will now be described in detail with reference to FIGS. 15-20A . It is noted that the movements of the various components will be described from the vantage point of one viewing the instrument as positioned in the referenced FIG.
- FIGS. 15-15C illustrate surgical stapling device 10 prior to use.
- cartridge assembly 20 and anvil assembly 22 are in spaced relation
- trigger 16 is in the non-compressed position
- clamp slides 66 a and 66 b and thrust bar 70 are in the retracted position (note pins 80 a and 80 b are positioned in the forward end of slots 78 a and 78 b of clamp slides 66 a and 66 b and slots 102 a and 102 b of thrust bar 70 ).
- thrust bar 70 is in the retracted position, the forward end of firing link 106 is positioned forwardly of notch 104 in thrust bar 70 . Since link 106 cannot engage notch 104 , device 10 cannot be fired in this position.
- Alignment pin pusher 68 and alignment pin 38 are also in the retracted position with post 94 of bell crank 96 engaged in C-clip 126 of alignment pin pusher 68 .
- a surgeon could manually advance alignment pin pusher 68 and alignment pin 38 by pushing thumb button(s) 24 ( FIG. 1 ) towards the forward end of slots 122 formed in body halves 12 a and 12 b . This operation would disengage post 94 from C-clip 126 .
- FIGS. 16-16C illustrate surgical stapling device 10 during the approximation stroke of trigger 16 .
- trigger 16 is moved in the direction indicated by arrow “A” to move extension 115 of trigger 16 in a direction to urge bi-linkage assembly 111 from the misaligned position towards the substantially aligned position.
- rear link 114 is secured to body 12 about pin 113 , front link 112 extends forwardly.
- Front link 112 is secured to clamp slides 66 a and 66 b by pin 88 .
- clamp slides 66 a and 66 b are advanced in the direction indicated by arrow “B” from the retracted position towards the advanced or approximated position.
- pins 80 a and 80 b are engaged in slots 78 a and 78 b and 102 a and 102 b .
- rivets 117 extend between clamp slides 66 a and 66 b through 103 formed in thrust bar 70 .
- rivet 88 engages the forward end of slot 103 formed in thrust bar 70 to simultaneously advance thrust bar 70 .
- engagement between cam slots 140 and cam member 138 pivots bell crank 96 about pivot member 134 to urge pin pusher 68 distally to advance alignment pin 38 into notch 30 c of anvil assembly 22 .
- cam member 180 on extension 115 of trigger 16 rides up cam surface 176 against the bias of spring 174 ( FIG. 4 ).
- cam member 180 snaps into cam recess 178 to provide an audible and a tactile indication that approximately three quarter approximation has been reached.
- the positioning of cam member 180 in cam recess 178 prevents spring 182 from returning trigger 16 to the non-compressed position without activating release mechanism 26 . Operation of the release mechanism will be discussed below.
- FIGS. 17-17C illustrate the surgical stapling device 10 in the fully approximated position with trigger 16 in the compressed position.
- extension 115 on trigger 16 has been pivoted to move bi-linkage assembly 111 to the substantially aligned positioned (slightly over-center position) and clamp slide assembly has been fully advanced such that cartridge assembly 20 and anvil assembly 22 are in the approximated position.
- pins 80 a and 80 b within clamp slide slots 78 a and 78 b and thrust bar slots 102 a and 102 b . Because pins 80 a and 80 b are located at the proximal end of clamp slide slots 78 a and 78 b , only thrust bar 70 can be advanced further distally.
- trigger 16 has been pivoted to remove cam member 180 from cam recess 178 in clamping pawl 108 .
- bi-linkage assembly 111 moves overcenter to the substantially aligned position
- rear link 114 engages abutment member 200 ( FIGS. 10-11 ) formed on clamping pawl 108 and firing pawl 110 to rotate the clamping and firing pawls approximately 10° counter-clockwise. This rotation removes cam surface 176 from the path of cam member 180 during the return of trigger 16 to the non-compressed position.
- cam member 180 ′ formed opposite to cam member 180 on extension 115 of trigger 16 is now positioned above cam surface 190 of firing pawl 110 .
- cam member 180 ′ moves along the backside 190 a of cam surface 190 .
- cam member 180 ′ moves over a nub 220 formed on firing pawl 110 . Movement of cam member 180 ′ over nub 220 provides an audible click and a tactile indication that surgical stapling apparatus 10 is in a fire-ready position.
- FIGS. 18-18C illustrate the surgical stapling device 10 in the fully approximated position with the trigger 16 in the non-compressed position.
- notch 104 is now aligned with firing link 106 such that movement of trigger 16 through the firing stroke will effect advancement of thrust bar 70 .
- camming member 180 ′ is now positioned below cam surface 190 of firing pawl 110 .
- FIGS. 19-19C illustrate surgical stapling instrument 10 after trigger 16 has been moved through the firing stroke.
- thrust bar 70 has been advanced distally to eject staples from cartridge assembly 20 .
- pins 80 a and 80 b are now positioned adjacent the proximal end of slots 102 a and 102 b .
- cam member 180 ′ of extension 115 of trigger 16 has moved up cam surface 190 and is positioned in recess 192 .
- Engagement between cam member 180 ′ and recess 192 prevents spring 182 from returning trigger 16 to the non-compressed position to provide a visual indication to the surgeon that the surgical device has been fired. Movement of cam member 180 ′ into recess 192 , also provides an audible indication that firing of the device has occurred.
- FIG. 20 illustrates surgical stapling device 10 after it has been fired and the release mechanism 26 has been depressed to return bi-linkage assembly 111 to the misaligned position.
- spring 71 returns thrust bar 70 and clamp slide members 66 a and 66 b proximally to return links 112 and 114 to the misaligned position.
- interlock 42 is normally urged by pusher assembly 54 to a position located within recess 40 . After cartridge assembly 20 has been fired, pusher assembly 54 is no longer positioned to bias interlock 42 into recess 40 . Until a new cartridge has been inserted into surgical stapling device 10 , interlock 42 will extend from recess 40 to prevent thrust bar 70 from being advanced distally.
- FIG. 21 illustrates tissue 300 having an applied array of staples 310 formed therein.
- FIG. 22 illustrates tissue 300 after it has been bisected with a scalpel (not shown).
- the components of the surgical stapling device can be formed of any material suitable for surgical use and having the required strength characteristics. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
Abstract
A surgical stapling device for applying an array of surgical staples to tissue is provided. The stapling device includes an approximation mechanism for moving a cartridge assembly and an anvil assembly between spaced and approximated positions and a firing mechanism for ejecting the array of staples from the cartridge assembly. A single trigger is operable to effect approximation and firing of the device. The device also includes an alignment pin assembly which can be selectively manually or automatically advanced. The anvil assembly includes a stiffener plate which allows the device to have a reduced head portion profile.
Description
- This application is a continuation of U.S. patent application Ser. No. 10/783,126, filed on Feb. 20, 2004, which is a continuation of U.S. patent application Ser. No. 09/687,815, filed on Oct. 13, 2000. Each of which is incorporated herein in its entirety by reference.
- 1. Technical Field
- The present disclosure relates generally to a surgical stapling apparatus and, more specifically, to a surgical stapling apparatus having a single trigger for approximating anvil and cartridge assemblies and for ejecting an array of staples from the cartridge assembly.
- 2. Background of Related Art
- Surgical stapling instruments used for applying parallel rows of staples through compressed living tissue are well known in the art, and are commonly used, for example, for closure of tissue or organs prior to transection, prior to resection, or in anastomoses, and for occlusion of organs in thoracic and abdominal procedures.
- Typically, such surgical stapling instruments include an anvil assembly, a cartridge assembly for supporting an array of surgical staples, an approximation mechanism for approximating the anvil and cartridge assemblies, an alignment pin assembly for capturing tissue between the cartridge and anvil assemblies and for maintaining alignment between the cartridge and anvil assemblies during approximation and firing, and a firing mechanism for ejecting the surgical staples from the cartridge assembly. The approximation mechanism and the firing mechanism generally include distinct actuators for effecting approximation and firing of the staples. The alignment pin assembly can be manually operated to advance an alignment pin from the cartridge assembly into engagement with the anvil or, alternatively, the alignment pin assembly can be automatically actuated upon operation of the approximation mechanism. In instruments having a manually operated alignment pin assembly, the actuator for the alignment pin assembly is disposed at a location spaced from the handle of the instrument.
- U.S. Pat. No. 4,930,503 to Pruitt discloses such a surgical stapling instrument. Pruitt's instrument includes a manually operated alignment pin assembly, an approximation mechanism including a rotatable knob actuator and a firing mechanism including a pivotable trigger. In use, a surgeon must first approximate the anvil and cartridge members by rotating the knob actuator. Next, the surgeon can advance the alignment pin assembly by advancing a knob supported on the central body portion of the instrument. Thereafter, the instrument can be fired by pivoting the trigger towards a stationary handle of the instrument.
- U.S. Pat. No. 5,697,543 to Burdorff also discloses a surgical stapling instrument having an approximation mechanism, a firing mechanism and an alignment pin mechanism. The approximation and firing mechanisms each include a distinct pivotable trigger actuator. The alignment pin mechanism is operatively associated with the approximation mechanism such that upon actuation of the approximation mechanism, the alignment pin assembly is automatically advanced.
- Known prior art surgical staplers are lacking in several respects. Firstly, the use of multiple actuators to effect approximation and firing of the instruments complicate the manufacture and operation of the instrument and, in most cases, require the surgeon to use two hands to hold and operate the instrument. Secondly, the instruments in which the alignment pin assembly is operatively associated with the approximation mechanism require that the instrument be approximated to advance the alignment pin assembly, despite the fact that a surgeon may prefer to advance the alignment pin assembly prior to approximation. In contrast, the instruments in which the alignment pin assembly is manually advanced typically require the surgeon to use a second hand to actuate the alignment pin assembly.
- Accordingly, a continuing need exists for a surgical stapling instrument which can be operated by a surgeon with a single hand and which includes an alignment pin assembly which can be automatically or manually advanced.
- In accordance with the present disclosure, a surgical stapling device is provided which includes a frame having a proximal end and a distal end. A body defining a stationary handle is secured to the proximal end of the frame. A head portion including an anvil assembly and a cartridge assembly are supported on the distal end of the frame. The anvil and cartridge assemblies are movable in relation to each other between spaced and approximated positions. An approximation mechanism includes a clamp slide assembly having a distal end configured to support the cartridge assembly and a proximal end. A firing mechanism includes a thrust bar having a distal end positioned to be slidably received within the cartridge assembly. A pivotable trigger is supported on the body and is operably associated with the approximation mechanism and the firing mechanism such that the trigger is pivotable through an approximation stroke to approximate the anvil and cartridge assemblies and, subsequently, pivotable through a firing stroke to eject an array of staples from the cartridge assembly.
- The presently disclosed surgical stapling device also has an alignment pin assembly which includes an alignment pin, a pin pusher and a bell crank. The alignment pin pusher is slidably supported on the frame between advanced and retracted positions. The alignment pin pusher includes a distal abutment member for engaging and advancing the alignment pin from a retracted position located within the cartridge assembly to an advanced position engaging the anvil assembly. The bell crank is operably connected to the clamp slide assembly and is releasably coupled to the pin pusher. Upon advancement of the clamp slide assembly, the bell crank is pivoted to concurrently advance the alignment pin pusher. The alignment pin pusher includes a pair of posts which extend through slots in the body. A thumb button is supported on each post. The thumb button(s) can be pushed prior to approximation of the device to manually advance the alignment pin assembly into engagement with the anvil assembly. The thumb buttons are positioned on the body such that a surgeon is able to manually advance the alignment pin assembly using the same hand that actuates the pivotable trigger.
- A pawl mechanism is supported in the body and includes a clamping pawl and a firing pawl. The clamping pawl functions to prevent return of the approximation mechanism after the trigger has moved through approximately three quarters of the approximation stroke. The clamping pawl also provides an audible and tactile indication that the device has been moved to the approximately three quarter approximated position. The firing pawl functions to provide an audible indication that the device is in a fire-ready position. The firing pawl also functions to lock the trigger in a compressed position after firing of the device has occurred to provide a visual indication that firing has occurred. A release button is provided to return the approximation mechanism to the retracted position at any point of operation of the device. The pivotable trigger, the release button and the thumb button are all disposed adjacent the handle portion of the device and are operable by the surgeon using a single hand.
- The anvil assembly of the surgical stapling device is provided with a stiffener plate to provide increased strength to the assembly. By using the stiffener plate, the head portion profile can be reduced in size.
- Preferred embodiments of the presently disclosed surgical stapling apparatus are described herein with reference to the drawings, wherein:
-
FIG. 1 is a perspective view of one embodiment of the presently disclosed surgical stapling device; -
FIG. 2 is a side view of the surgical stapling device shown inFIG. 1 ; -
FIG. 3 is a top view of the surgical stapling device shown inFIG. 1 ; -
FIG. 4 is a perspective view with parts separated of the surgical stapling device shown inFIG. 1 ; -
FIG. 5 is a perspective view of the surgical stapling device shown inFIG. 1 with the left body half-section removed from the handle portion of the device; -
FIG. 6 is a perspective view of the handle portion of the surgical stapling device shown in -
FIG. 7 with a body half-section removed and a portion of the frame cutaway; -
FIG. 7 is an enlarged view of the indicated area of detail shown inFIG. 4 ; -
FIG. 8 is a rear perspective view of the staple pusher assembly of the surgical stapling device shown inFIG. 1 ; -
FIG. 8A is a rear perspective view of the staple pusher assembly shown inFIG. 8 with parts separated; -
FIG. 8B is a perspective view of an alternate embodiment of the staple pusher assembly shown inFIG. 8 with parts separated; -
FIG. 8C is a perspective view of the staple pusher assembly shown inFIG. 8B in an assembled state; -
FIG. 9 is an enlarged perspective view of the distal end of the surgical stapling device shown inFIG. 1 ; -
FIG. 9A is an enlarged view of the indicated area of detail shown inFIG. 9 ; -
FIG. 9B is a cross-sectional view taken alongsection lines 9B-9B ofFIG. 9A ; -
FIG. 10 is a perspective view from one side of the firing pawl of the surgical stapling device shown inFIG. 1 ; -
FIG. 10A is a perspective view from the other side of the firing pawl shown inFIG. 10 ; -
FIG. 11 is a perspective view from one side of the clamping pawl of the surgical stapling device shown inFIG. 1 ; -
FIG. 11A is a perspective view from the other side of the clamping pawl shown inFIG. 11 ; -
FIG. 12 is a perspective view with parts separated of the trigger and firing link of the surgical stapling device shown inFIG. 1 ; -
FIG. 13 is a perspective view with parts separated of the release button assembly and bi-linkage assembly of the surgical stapling device shown inFIG. 1 ; -
FIG. 14 is a perspective view with parts separated of the pin pusher and bell crank of the surgical stapling device shown inFIG. 1 ; -
FIG. 15 is a side cross-sectional view of the surgical stapling device taken along section lines XX-XX ofFIG. 3 ; -
FIG. 15A is a side partial cutaway view of the handle portion of the surgical stapling device shown inFIG. 1 with a body half-section removed; -
FIG. 15B is an enlarged view of the indicated area of detail shown inFIG. 15 ; -
FIG. 15C is an enlarged view of the indicated area of detail shown inFIG. 15A ; -
FIG. 16 is a side cross-sectional view of the surgical stapling device shown inFIG. 1 during approximation of the anvil and cartridge assemblies; -
FIG. 16A is a side partial cutaway view of the handle portion of the surgical stapling device shown inFIG. 1 during approximation of the anvil and cartridge assemblies with the left body half-section removed from the handle portion of the device; -
FIG. 16B is an enlarged view of the indicated areas of detail shown inFIG. 16 ; -
FIG. 16C is an enlarged view of the indicated area of detail shown inFIG. 16A . -
FIG. 17 is a side cross-sectional view of the surgical stapling device shown inFIG. 1 in the approximated position with the trigger in the compressed position; -
FIG. 17A is a side partial cutaway view of the handle portion of the surgical stapling device shown inFIG. 1 in the approximated position with the left body half-section and frame removed from the handle portion of the device and the trigger in the compressed position; -
FIG. 17B is an enlarged view of the indicated area of detail shown inFIG. 17 ; -
FIG. 17C is an enlarged view of the indicated area of detail shown inFIG. 17A . -
FIG. 18 is a side cross-sectional view of the surgical stapling device shown inFIG. 1 in the approximated position with the trigger in a fire-ready position; -
FIG. 18A is a side partial cutaway view of the handle portion of the surgical stapling device shown inFIG. 1 in the fully approximated position with the left body half-section and frame removed from the handle portion of the device and the trigger in a fire-ready position; -
FIG. 18B is an enlarged view of the indicated area of detail shown inFIG. 18 ; -
FIG. 18C is an enlarged view of the indicated area of detail shown inFIG. 18A . -
FIG. 19 is a side cross-sectional view of the surgical stapling device shown inFIG. 1 after the device has been fired with the trigger in a compressed and locked position; -
FIG. 19A is a side partial cutaway view of the handle portion of the surgical stapling device shown inFIG. 1 in the fired position with the left body half-section and frame removed from the handle portion of the device and the trigger in the compressed position; -
FIG. 19B is an enlarged view of the indicated area of detail shown inFIG. 19 ; -
FIG. 19C is an enlarged view of the indicated area of detail shown inFIG. 19A . -
FIG. 20 is a side cross-sectional view of the surgical stapling device shown inFIG. 1 after the staples have been fired from the staple cartridge and the cartridge assembly has been moved to the retracted position; -
FIG. 20A is an enlarged view of the indicated area of detail shown inFIG. 20 ; -
FIG. 21 is a top view of tissue illustrating the staple configuration applied to tissue by the surgical stapling device shown inFIG. 1 ; -
FIG. 22 is a top view of the tissue shown inFIG. 16 illustrating the staple configuration after the tissue has been cut; - Preferred embodiments of the presently disclosed surgical stapling device will now be described in detail with reference to the drawings, wherein like reference numerals designate corresponding elements in each of the several views.
- The presently disclosed surgical stapling device shown generally as 10 in
FIGS. 1-3 includes abody 12 defining astationary handle 14, apivotable trigger 16, an elongatedcentral body portion 18, acartridge assembly 20 and ananvil assembly 22. Athumb button 24 is slidably positioned on each side ofbody 12.Thumb buttons 24 are movable to manually advance an alignment pin assembly in a manner to be described in detail below. Arelease button 150 ofrelease mechanism 26 is positioned on the proximal end ofbody 12 and is depressible to allowcartridge assembly 20 to return from an approximated position disposed adjacent toanvil assembly 22 to a position spaced from anvil assembly 22 (as shown). Operation ofrelease mechanism 26 will also be described in detail below. - Referring to
FIG. 4 ,body 12 is formed from a pair of molded half-sections sections member 14 a is secured tostationary handle 14 of each half-section member 14 a may be formed by injection molding a thermoplastic elastomer, such as Versaflex™ or Santaprene, tostationary handle 14. Alternately, cushioned grippingmember 14 can be formed on or secured tostationary handle 14 using any known fastening technique including adhesives, screws, welding, overmolding, etc. A pair of spacedframe members 28 a and 28 b extend between housing half-sections anvil assembly 22. A central portion offrame members 28 a and 28 b form elongatedcentral body portion 18. Preferably,frame members 28 a and 28 b are formed of a surgical grade metal such as stainless steel. Alternately, other suitable materials meeting the requisite strength requirements may also be used. - Referring also to
FIGS. 9-9B ,anvil assembly 22 includes astiffener plate 30, aspacer plate 32, a T-track 34, and ananvil 36. Anopening 67 is formed inanvil 36 to allow passage ofalignment pin 38.Stiffener plate 30 has avertical portion 30 a and ahorizontal portion 30 b. Anotch 30 c is formed in the distal end ofvertical portion 30 a.Notch 30 c is configured to receive thetip 38 a of acartridge alignment pin 38.Horizontal portion 30 b ofplate 30 includes acutout 40 dimensioned to receive aninterlock member 42 which will be discussed in further detail below. In the assembled state, a distal vertical portion offrame members 28 a and 28 b are positioned on opposite sides ofvertical portion 30 a ofstiffener plate 30.Spacer plate 32 includes a pair of legs which are positioned on opposite sides ofstiffener plate 30 betweenstiffener plate 30 andanvil 36.Anvil 36 defines achannel 36 a and is positioned aboutspacer plate 32. Acap 39 is positioned over the assembly to provide a smoother surface which is less likely to snag tissue during use.Cap 39 includes agroove 39 a which defines one end of a cuttingguide slot 41 formed betweenanvil 36 and frame member 28 b.Groove 39 a and cuttingguide slot 41 facilitate cutting of tissue with a scalpel afterdevice 10 has been fired. T-track 34 defines a throughslot 45.Slot 45 is positioned overhorizontal portion 30 b ofstiffener plate 30 betweenframe members 28 a and 28 b. T-track 34 is positioned aboutcutout 40 to define a cavity in which interlock 42 is positioned. Preferably, the anvil assembly components andframe members 28 a and 28 b are secured together using rivets 44 (FIG. 5 ). Alternately, other fastening members may be used to secure the anvil assembly components and the frame members together including screws, pins, welding, etc. Preferably, the components ofanvil assembly 22 are formed of stainless steel. Alternately, other materials, including metals, having requisite strength requirements can be used to form some or all of the anvil components. - Referring to
FIG. 9 ,anvil 36 includes a plurality ofstaple pockets 37 formed in the surface of the anvil. Eachstaple pocket 37 includes first and secondstaple forming cups 37 a and 37 b and a channelingsurface 37 c disposed around each of the staple forming cups. An anvil including such a staple forming pocket has been disclosed in U.S. Pat. No. 5,480,089 filed Aug. 19, 1994, the entirety of which is incorporated herein by reference. - Referring to
FIGS. 4 and 7 -8A,cartridge assembly 20 includes acartridge 50 having an array ofstaple receiving slots 52. Astaple pusher assembly 54 includes a plurality ofpusher members 58. Eachpusher member 58 includes a plurality offingers 58 a configured to be slidably received within a respectivestaple receiving slot 52.Fingers 58 a are positioned behindstaples 56 inslots 52 such that advancement offingers 58 a effects ejection ofstaples 56 fromslots 52. A guide channel 60 (FIG. 15 ) formed incartridge 50 is configured to slidably receivealignment pin 38. Aspring 64 is positioned aboutpin 38 to urgealignment pin 38 to a retracted position withinguide channel 60. Anopening 65 formed incartridge 50 allowsalignment pin 38 to extend fromguide channel 60 through anvil opening 67 (FIG. 9A ) intonotch 30 c formed inanvil assembly 22. Operation of the alignment pin mechanism for advancingalignment pin 38 will be described in detail below. - Referring also to
FIGS. 8B and 8C ,staple pusher assembly 54 includesmultiple pusher members 58 which interengage to formpusher assembly 54.Pusher assembly 54 may be modified by adding or subtractingpusher members 58 to accommodate different size cartridges. For example, apusher member 58 can be removed from the assembly such as shown inFIGS. 8B and 8C to accommodate a smaller cartridge assembly. - Referring to
FIGS. 4 and 5 ,surgical stapling device 10 includes a pair ofclamp slide members alignment pin pusher 68 and athrust bar 70.Clamp slide members alignment pin pusher 68 and thrustbar 70 are slidably supported betweenframe members 28 a and 28 b for movement between retracted and advanced positions in response to movement oftrigger 16 through an approximation stroke and/or a firing stroke. Operation of each of the above members will be described in detail below. -
Clamp slide members distal end 72, aproximal end 74 and anelongated body 76.Elongated body 76 includes a pair ofelongated guide slots 78 a and 78 b.Guide slots 78 a and 78 b are dimensioned to slidably receivepins FIG. 15 ), respectively, which extend betweenframe members 28 a and 28 b. The positioning ofpins guide slots 78 a and 78 b functions to maintain alignment betweenclamp slide members frame members 28 a and 28 b during movement between the advanced and retracted positions and to limit the extent of longitudinal movement ofclamp slide members slot 78 a engagespin 80 a and the fully retracted position of the clamp slide members is reached when the distal end ofslot 78 a engagespin 80 a.Distal end 72 of eachclamp slide member head portion 82. Eachhead portion 82 has a plurality ofopenings 84 configured to receive a fastening member 86 (FIG. 5 ) for securingclamp slide members slide members pin pusher 68 and thrustbar 70 are slidably disposed.Distal end 72 ofclamp slide members cartridge assembly 20. A series ofdimples 85 on each of the clamp slide members function to frictionally retaincartridge assembly 20 within the cartridge support.Proximal end 74 ofclamp slide members hole 87 for receiving apin 88 of the actuation assembly which will be described in detail below. - Referring also to
FIG. 14 ,alignment pin pusher 68 defines achannel 69 along its length which is dimensioned to slidably receive thrustbar 70.Alignment pin pusher 68 includes avertical portion 90 having anabutment member 91 configured to engage theproximal end 38 b (FIG. 4 ) ofalignment pin 38 such that whenalignment pin pusher 68 is moved to an advanced position (in the manner described below),alignment pin 38 is advanced from withincartridge 50 throughopening 65 incartridge 50 andopening 67 inanvil 36 intonotch 30 c ofanvil assembly 22.Alignment pin pusher 68 includes a pair ofelongated slots 92 a and 92 b.Pins FIG. 15 ) extend throughslots 92 a and 92 b, respectively, to guidealignment pin pusher 68 during movement between the advanced and retracted positions. The proximal end ofalignment pin pusher 68 includes a pair of spacedlegs 68 a and 68 b. Eachleg 68 a and 68 b includes aradially extending post 120 which is dimensioned to extend through elongated slots 122 (FIG. 4 ) formed in body half-sections Thumb buttons 24 are fastened toposts 120 to facilitate manual actuation ofalignment pin pusher 68. A C-clip receptacle 126 is formed onalignment pin pusher 68 and is dimensioned to releasably receivelink 94 ofbell crank 96. Operation of bell crank 96 and the handle actuation assembly will be described in detail below. - Referring again to
FIG. 4 , thrustbar 70 is slidably positioned withinchannel 69 defined withinalignment pin pusher 68. The distal end ofthrust bar 70 includes anengagement head 100 configured to engagestaple pusher assembly 54.Thrust bar 70 also includes a pair ofelongated slots pins FIG. 15 ). As discussed above with respect to clampslide members thrust bar 70 between the retracted and advanced positions, but also to define the fully advanced and fully retracted positions ofthrust bar 70. As illustrated inFIG. 15 ,slots thrust bar 70 are longer thanslots 78 a and 78 b formed in clamp slides 66 a and 66 b, respectively. The increased length ofslots bar 70 to be advanced distally from the approximated position independently of clamp slides 66 a and 66 b throughcartridge assembly 20 to eject staples fromcartridge assembly 20. The proximal end ofthrust bar 70 is adapted to engage a biasingmember 71 which is supported in tension betweenframe 28 a and thrustbar 70 to urge thrustbar 70 to the retracted position. The proximal end ofthrust bar 70 also includes anotch 104 which is configured to receive the distal end of afiring link 106 and will be discussed in further detail below. - Referring to
FIGS. 4-6 , and 10-13, a handle actuation assembly includespivotable trigger 16, abi-linkage assembly 111 including afront link 112 and arear link 114, bell crank 96, firing link 106 a clampingpawl 108 and afiring pawl 110. Arelease mechanism 26 includes arelease button 150 and arelease lever 152 provided withinbody 12. -
Pivotable trigger 16 is pivotably secured between body half-sections pivot members 116 which are integrally formed on opposite sides oftrigger 16. Alternately, a pivot pin can be used topivotably support trigger 16 between the body half-sections.Trigger 16 includes a cushionedgrip 16 a, which may be secured to trigger 16 in the manner discussed above with respect tostationary handle 14, and arearward extension 115 positioned beneathbi-linkage assembly 111. Rear link 114 ofbi-linkage assembly 111 has a rear end pivotably secured aboutpivot pin 113 which extends betweenbody members front link 112 bypivot pin 118. It is noted thatrelease button 150 is also pivotably secured to pivotpin 113. The forward end offront link 112 is pivotably fastened to clampslide members pin 88. Whentrigger 16 is pivoted aboutpivot members 116,rearward extension 115 urgesbi-linkage assembly 111 from a position in which the longitudinal axes of front andrear links rear links bi-linkage assembly 111 will not return to the misaligned position until engaged by therelease mechanism 26. Since the rear end ofrear link 114 is fastened withinbody 12, asbi-linkage assembly 111 is moved from the misaligned to the aligned position,front link 112 is advanced distally to advanceclamp slide members clamp slide members cartridge assembly 20 to effect approximation of anvil andcartridge assemblies - Referring to
FIGS. 4 and 15 , thrustbar 70 includes a forwardelongated slot 103.Rivets 117, which extend betweenclamp slide members slot 103. Whenclamp slide members slot 103 to advance thrustbar 70 concurrently withclamp slide members FIG. 15 ,slot 103 is of a length to allow thrustbar 70 to advance distally beyond the approximated position independently ofclamp slide members - Referring to
FIGS. 4 and 14 , bell crank 96 is pivotably secured betweenframe members 28 a and 28 b bypivot member 134. As discussed above, link 94 ofbell crank 96 is releasably positioned within C-clipl 26 ofalignment pin pusher 68. Bell crank 96 includes a pair of spaced sidewalls 96 a and 96 b. Each sidewall includes an inwardly extendingcam member 138 which is configured to be received within acam slot 140 formed in the proximal end of clamp slides 66 a and 66 b. As clamp slides 66 a and 66 b are advanced distally, the walls definingcam slots 140 engagecam members 138 to pivot bell crank 96 aboutpivot member 134. Whenbell crank 96 is pivoted, post 94urges pin pusher 68 distally to advanceabutment member 91 throughguide channel 60 to advancealignment pin 38 into engagement withanvil assembly 22.Cam slots 140 are configured to quickly pivot bell crank 96 during the initial advancement of clamp slides 66 a and 66 b such as to quickly advancealignment pin pusher 68 andalignment pin 38 during the initial stage of approximation. - Referring again to
FIGS. 4 and 13 ,release mechanism 26 includesrelease button 150 andrelease lever 152. As discussed above,release button 150 includes a rear end which is pivotably secured to pivotpin 113.Pivot pin 113 is secured betweenbody members release button 150 includes aslot 154 dimensioned to slidably receive arod 156 formed on a rear end ofrelease lever 152. The forward end ofrelease lever 152 is pivotably secured between body half-sections engagement member 158 projects downwardly from the bottom ofrelease lever 152 and is positioned to abutbi-linkage assembly 111 whenrelease button 150 is depressed to urgebi-linkage assembly 111 from the substantially aligned overcenter position to the misaligned position. - Referring to
FIGS. 4 and 10 -12,surgical stapling apparatus 10 includes a pawl assembly including clampingpawl 108 and firingpawl 110. Clampingpawl 108 is pivotably secured aboutpivot member 170 in semi-circular slot 172 (FIG. 4 ) inframe 28 a. Aspring 174 is secured between clampingpawl 108 and frame 28 a to urge clampingpawl 108 to rotate in a clockwise direction as viewed inFIG. 4 . Clampingpawl 108 includes acam surface 176 having arecess 178 positioned to engage cam member 180 (FIG. 16B ) formed onextension 115 oftrigger 16. Whencam member 180 ontrigger 16 is positioned inrecess 178 of cam surface 176 (this occurs after the clamp slides 66 a and 66 b have been moved through approximately three quarters of the approximation stroke),trigger 16 is prevented from being returned byspring 182 to a non-compressed position. Thus, thecartridge assembly 20 and theanvil assembly 22 are maintained in a three quarter approximated position even whentrigger 16 is released by the surgeon. Firingpawl 110 is pivotably secured aboutpivot member 184 in semi-circular slot 186 (FIG. 4 ) formed in frame 28 b.Spring 188 is secured between firingpawl 110 and frame 28 b to urge the firing pawl in a clockwise direction as viewed inFIG. 4 . Firingpawl 110 includes acam surface 190 having arecess 192 for engaging acam member 180′ formed on a side ofextension 115 oftrigger 16opposite cam member 180. During movement oftrigger 16 through the firing stroke,cam member 180′ is moved intorecess 192 to locktrigger 16 in a compressed position after firing has been completed. This provides an audible and visual indication to the surgeon that firing has been completed. Additional operational details of the pawl assembly will be described in the following description of the operation ofsurgical stapling device 10. - Operation of the surgical stapling device will now be described in detail with reference to
FIGS. 15-20A . It is noted that the movements of the various components will be described from the vantage point of one viewing the instrument as positioned in the referenced FIG. -
FIGS. 15-15C illustratesurgical stapling device 10 prior to use. As illustrated,cartridge assembly 20 andanvil assembly 22 are in spaced relation, trigger 16 is in the non-compressed position, and clamp slides 66 a and 66 b and thrustbar 70 are in the retracted position (note pins 80 a and 80 b are positioned in the forward end ofslots 78 a and 78 b of clamp slides 66 a and 66 b andslots bar 70 is in the retracted position, the forward end of firinglink 106 is positioned forwardly ofnotch 104 inthrust bar 70. Sincelink 106 cannot engagenotch 104,device 10 cannot be fired in this position.Alignment pin pusher 68 andalignment pin 38 are also in the retracted position withpost 94 of bell crank 96 engaged in C-clip 126 ofalignment pin pusher 68. At this point, a surgeon could manually advancealignment pin pusher 68 andalignment pin 38 by pushing thumb button(s) 24 (FIG. 1 ) towards the forward end ofslots 122 formed in body halves 12 a and 12 b. This operation would disengage post 94 from C-clip 126. -
FIGS. 16-16C illustratesurgical stapling device 10 during the approximation stroke oftrigger 16. As illustrated,trigger 16 is moved in the direction indicated by arrow “A” to moveextension 115 oftrigger 16 in a direction to urgebi-linkage assembly 111 from the misaligned position towards the substantially aligned position. Becauserear link 114 is secured tobody 12 aboutpin 113,front link 112 extends forwardly.Front link 112 is secured to clampslides pin 88. Asfront link 112 is extended forwardly, clamp slides 66 a and 66 b are advanced in the direction indicated by arrow “B” from the retracted position towards the advanced or approximated position. Note the position ofpins slots thrust bar 70. As clamp slides 66 a and 66 b are advanced, rivet 88 engages the forward end ofslot 103 formed inthrust bar 70 to simultaneously advance thrustbar 70. As clamp slides 66 a and 66 b are advanced, engagement betweencam slots 140 andcam member 138 pivots bell crank 96 aboutpivot member 134 to urgepin pusher 68 distally to advancealignment pin 38 intonotch 30 c ofanvil assembly 22. - Referring to
FIG. 16B , astrigger 16 is pivoted in the direction indicated by arrow “A”,cam member 180 onextension 115 oftrigger 16 rides upcam surface 176 against the bias of spring 174 (FIG. 4 ). Whentrigger 16 is pivoted to advanceclamp slide members 66 c and 66 b through approximately three quarters of the approximation stroke,cam member 180 snaps intocam recess 178 to provide an audible and a tactile indication that approximately three quarter approximation has been reached. At this point, the positioning ofcam member 180 incam recess 178 preventsspring 182 from returningtrigger 16 to the non-compressed position without activatingrelease mechanism 26. Operation of the release mechanism will be discussed below. -
FIGS. 17-17C illustrate thesurgical stapling device 10 in the fully approximated position withtrigger 16 in the compressed position. As illustrated,extension 115 ontrigger 16 has been pivoted to movebi-linkage assembly 111 to the substantially aligned positioned (slightly over-center position) and clamp slide assembly has been fully advanced such thatcartridge assembly 20 andanvil assembly 22 are in the approximated position. Once again, note the position ofpins clamp slide slots 78 a and 78 b and thrustbar slots pins clamp slide slots 78 a and 78 b, only thrustbar 70 can be advanced further distally. If the alignment pin pusher was manually advanced prior to approximation, disengagingpost 94 from C-clip 126, advancement of clamp slides 66 a and 66 b to the fully advanced position moves post 94 of bell crank 96 back into engagement with C-clip 126. Thus, when clamp slides 66 a and 66 b are returned to their retracted position,cam slots 140 in clamp slides 66 a and 66 b pivot bell crank 96 in a direction to movepin pusher 68 to the retracted position. - Referring to
FIG. 17B , trigger 16 has been pivoted to removecam member 180 fromcam recess 178 in clampingpawl 108. Asbi-linkage assembly 111 moves overcenter to the substantially aligned position,rear link 114 engages abutment member 200 (FIGS. 10-11 ) formed on clampingpawl 108 and firingpawl 110 to rotate the clamping and firing pawls approximately 10° counter-clockwise. This rotation removescam surface 176 from the path ofcam member 180 during the return oftrigger 16 to the non-compressed position. - Referring to
FIG. 17C cam member 180′ formed opposite tocam member 180 onextension 115 oftrigger 16 is now positioned abovecam surface 190 of firingpawl 110. Astrigger 16 is released by the surgeon and returned to the non-compressed position byspring 182,cam member 180′ moves along thebackside 190 a ofcam surface 190. Ascam member 180′ reaches the bottom edge ofbackside 190 a,cam member 180′ moves over anub 220 formed on firingpawl 110. Movement ofcam member 180′ overnub 220 provides an audible click and a tactile indication thatsurgical stapling apparatus 10 is in a fire-ready position. -
FIGS. 18-18C illustrate thesurgical stapling device 10 in the fully approximated position with thetrigger 16 in the non-compressed position. As illustrated, withthrust bar 70 in an advanced position, notch 104 is now aligned with firinglink 106 such that movement oftrigger 16 through the firing stroke will effect advancement ofthrust bar 70. Referring toFIG. 18C ,camming member 180′ is now positioned belowcam surface 190 of firingpawl 110. -
FIGS. 19-19C illustratesurgical stapling instrument 10 aftertrigger 16 has been moved through the firing stroke. As illustrated, thrustbar 70 has been advanced distally to eject staples fromcartridge assembly 20. Note pins 80 a and 80 b are now positioned adjacent the proximal end ofslots FIG. 19C ,cam member 180′ ofextension 115 oftrigger 16 has moved upcam surface 190 and is positioned inrecess 192. Engagement betweencam member 180′ andrecess 192 preventsspring 182 from returningtrigger 16 to the non-compressed position to provide a visual indication to the surgeon that the surgical device has been fired. Movement ofcam member 180′ intorecess 192, also provides an audible indication that firing of the device has occurred. -
FIG. 20 illustratessurgical stapling device 10 after it has been fired and therelease mechanism 26 has been depressed to returnbi-linkage assembly 111 to the misaligned position. Oncebi-linkage assembly 111 is moved back overcenter,spring 71 returns thrustbar 70 andclamp slide members links - As illustrated in
FIG. 20A ,interlock 42 is normally urged bypusher assembly 54 to a position located withinrecess 40. Aftercartridge assembly 20 has been fired,pusher assembly 54 is no longer positioned to biasinterlock 42 intorecess 40. Until a new cartridge has been inserted intosurgical stapling device 10,interlock 42 will extend fromrecess 40 to prevent thrustbar 70 from being advanced distally. -
FIG. 21 illustratestissue 300 having an applied array ofstaples 310 formed therein.FIG. 22 illustratestissue 300 after it has been bisected with a scalpel (not shown). - It will be understood that various modifications may be made to the embodiments disclosed herein. For example, the components of the surgical stapling device can be formed of any material suitable for surgical use and having the required strength characteristics. Therefore, the above description should not be construed as limiting, but merely as exemplifications of preferred embodiments. Those skilled in the art will envision other modifications within the scope and spirit of the claims appended hereto.
Claims (16)
1. (canceled)
2. A surgical stapling device comprising:
a frame having first and second ends;
a body portion defining a handle;
a trigger supported adjacent the handle;
an anvil assembly secured to the second end of the frame;
a cartridge assembly movably supported in relation to the anvil assembly between spaced and approximated positions; and
means for strengthening the anvil assembly, wherein the strengthening means is supported at the second end of the frame.
3. A surgical stapling device according to claim 2 , wherein the strengthening means includes a stiffener plate.
4. A surgical stapling device according to claim 3 , wherein the stiffener plate is substantially L-shaped, the stiffener plate being secured to the second end of the frame to provide support to the anvil assembly along horizontal and vertical axes.
5. A surgical stapling device according to claim 4 , wherein the frame includes left and right spaced frame sections.
6. A surgical stapling device according to claim 5 , wherein the stiffener plate is positioned between the left and right frame sections.
7. A surgical stapling device according to claim 2 , wherein the stiffener plate is formed of stainless steel.
8. A surgical stapling device according to claim 2 , wherein the frame includes left and right frame sections.
9. A surgical stapling device according to claim 8 , wherein the stiffener plate is positioned between the left and right frame sections.
10. A surgical stapling device according to claim 9 , further including a spacer plate positioned about the stiffener plate between the left and right frame sections.
11. A surgical stapling device according to claim 3 , wherein the stiffener plate includes a slot adapted to slidably receive an interlock, the interlock being movable from a first position to a second position to prevent distal movement of a thrust bar of the stapling device.
12. A surgical stapling device comprising:
a frame having first and second ends:
a handle supported at the first end of the frame;
a trigger supported adjacent the handle;
an anvil supported on the second end of the frame;
a cartridge assembly movably supported on the second end of the frame, the cartridge assembly being movable in relation to the anvil assembly between spaced and approximated positions; and
a stiffener plate supported on the second end of the frame adjacent the anvil, the stiffener plate being substantially L-shaped to provide vertical and horizontal stability to the anvil.
13. A surgical stapling device according to claim 12 , wherein the frame includes left and right frame sections, the stiffener plate being positioned between the left and the right frame sections.
14. A surgical stapling device according to claim 12 , wherein the stiffener plate is formed of stainless steel.
15. A surgical stapling device according to claim 13 , further including a spacer plate positioned about the stiffener plate between the left and right frame sections.
16. A surgical stapling device according to claim 15 , wherein the stiffener plate includes a slot adapted to slidably receive an interlock, the interlock being movable from a first position to a second position to inhibit distal movement of a thrust bar of the stapling device.
Priority Applications (7)
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US11/125,790 US20050263563A1 (en) | 2000-10-13 | 2005-05-10 | Surgical stapling device |
US11/436,282 US7275674B2 (en) | 2000-10-13 | 2006-05-18 | Surgical stapling device |
US11/590,458 US7407076B2 (en) | 2000-10-13 | 2006-10-31 | Surgical stapling device |
US11/904,566 US8033439B2 (en) | 2000-10-13 | 2007-09-27 | Surgical stapling device |
US13/221,331 US8371494B2 (en) | 2000-10-13 | 2011-08-30 | Surgical stapling device |
US13/741,459 US8777083B2 (en) | 2000-10-13 | 2013-01-15 | Surgical stapling device |
US14/294,188 US9427231B2 (en) | 2000-10-13 | 2014-06-03 | Surgical stapling device |
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US10/783,126 US20040164123A1 (en) | 2000-10-13 | 2004-02-20 | Surgical stapling device |
US11/125,790 US20050263563A1 (en) | 2000-10-13 | 2005-05-10 | Surgical stapling device |
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US11/436,282 Continuation US7275674B2 (en) | 2000-10-13 | 2006-05-18 | Surgical stapling device |
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US13/221,331 Expired - Fee Related US8371494B2 (en) | 2000-10-13 | 2011-08-30 | Surgical stapling device |
US13/741,459 Expired - Fee Related US8777083B2 (en) | 2000-10-13 | 2013-01-15 | Surgical stapling device |
US14/294,188 Expired - Fee Related US9427231B2 (en) | 2000-10-13 | 2014-06-03 | Surgical stapling device |
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US10/783,126 Abandoned US20040164123A1 (en) | 2000-10-13 | 2004-02-20 | Surgical stapling device |
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US13/221,331 Expired - Fee Related US8371494B2 (en) | 2000-10-13 | 2011-08-30 | Surgical stapling device |
US13/741,459 Expired - Fee Related US8777083B2 (en) | 2000-10-13 | 2013-01-15 | Surgical stapling device |
US14/294,188 Expired - Fee Related US9427231B2 (en) | 2000-10-13 | 2014-06-03 | Surgical stapling device |
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EP (4) | EP1324707B1 (en) |
JP (4) | JP2004528859A (en) |
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